TILT TABLE TEST: What is it?

A tilt table test is also sometimes called a head-up tilt test. During one, your blood pressure and heart rate will be monitored by the minute. You lie down on the table and are strapped down while it is in a flat horizontal position. The table is gradually tilted up to different levels and you are monitored for changes in BP and HR.  You will have an IV inserted during the test in case medications are needed.

The purpose of the test is to help your doctors figure out what is causing your light-headedness and/or fainting spells, sometimes called syncope.

Syncope is when you lose consciousness due to a decrease in blood flow to your brain. This can be caused by a sudden drop in blood pressure or an increase in heart rate or by a large amount of your blood volume shifting to your lower extremities. It is frequently due to some medical condition related to your nervous system, heart or the amount of blood flow to your brain.

Depending on what the results are, your doctor can then determine the best course of treatment for you and if other tests might be needed.

A couple of things can happen when you have a Tilt Table Test or when you stand up. Depending on how your sympathetic nervous system reacts, you can have either POTS or NMH,(Neurally Mediated Hypotension).

NMH is most likely to occur is you have a decrease in norepinephrine and an increase in epinephrine. POTS is the opposite, it is most likely to result from an increase in norepinephrine and a decrease in epinephrine. These hormones are sometimes referred to as catecholamines.

Don't forget to watch the POTS videos at the bottom of the blog. You have to scroll down for them.

DIFFERENT TYPES OF POTS and SOME ASSOCIATED ILLNESSES

Neuropathic POTS ideology--POTS is an autonomic neuropathy. Nerves in the peripheral nervous system or,Small fibers that control autonomic functions and control pain are malfunctioning. About 50% of people with POTS have this type.

Hypo-adrenergic POTS--People with this type make more norepinephrine and epinephrine than normal people. NMH (ORTHOSTATIC HYPOTENSION) is most likely to occur is you have a decrease in norepinephrine and an increase in epinephrine. POTS is the opposite, it is most likely to result from an increase in norepinephrine and a decrease in epinephrine. About 33% of patients have this type.

Hypovolemic POTS--Blood Volume and urine sodium is low.About 33% have this type. Hypovolemia is Hypovolemia (also hypovolaemia or oligemia) when your body is in  a state of decreased blood volume. More precisely, you have a decrease in volume of blood plasma. It is what happens inside your blood vessels due to things like bleeding or dehydration.

Hypovolemia is related to sodium (salt) depletion which causes loss of water inside the blood vessels and is different from dehydration, which is excessive loss of body water. Symptoms of hypovolemia are tachycardia, low blood pressure, and lack of adequate blood flow which causes paleness of the skin and/or capillary refill on  the forehead, lips and nail beds. This is the time it takes  normal color to return to the skin or nail beds after pressure is applied. Other symptoms include feeling dizzy, faint, nauseated, or very thirsty. These are similar to the symptoms of shock.

Patients can have more than one type.

There is a genetic predisposition in some patients. Someone else in your family may have it. In my husband's family, his mother had it, but never got a diagnosis. And in my family, my father had it. There are major genetic things going on with my case. My father also had Parkinson's and it is genetic in our family. And in addition to this, my father had Rheumatoid Arthritis and a few secondary autoimmune conditions. I, in turn,  have,SLE (Systemic Lupus Erythematosus), Sjogren's Syndrome and other autoimmune conditions.

Typically, when you read about autonomic dysfunction, you read about a connection to Joint Hypermobility Syndrome or EDH(Ehlers-Danlos syndrome hypermobility type) . But they are autoimmune in nature, so Lupus and Rheumatoid Arthritis are not a stretch.

Parkinson's Disease is also common to read about in conjunction with autonomic dysfunction.

Other things that are connected are anemia, tumors, lightning injury(my husband was hit by lightning twice, see Page about it over on the side and read post about it here for more links), mitochondrial disease, porphyrias.


Don't forget to check out the videos at the bottom on POTS. You have to scroll down to find them.

IS POTS AN AUTOIMMUNE DISEASE? The Connection Between Dysautonomia and Autoimmunity

It is a recognized fact that some autoimmune diseases  also cause POTS, like Sjogren's Syndrome or Systemic Lupus Erythematosus. This is because these diseases cause damage called neuropathy by causing your body to produce autoantibodies that attack nerve cells/fibers.


But is POTS itself an autoimmune disease?

I happen to have both. I found this interesting article on the subject. New evidence of autoimmunity in POTS!  

There are a few other autoimmune diseases known to cause POTS. Guillain-Barre Syndrome and  CIDP, Chronic Inflammatory Demyelinating Polyneuropathy. Guillain-Barre works both like an infection and an autoimmune disorder simultaneously. It causes nerve inflammation and damages the protective myelin sheath covering the nerves. As a result, the nerve signals travel too slowly and can result in the nerve fibers being totally destroyed. It usually comes on suddenly after a GI infection or lung infection. The end result is some degree of motor function loss or damage to the motor nerves. CIDP is a more chronic form of Guillain-Barre.

They did a study to find out whether or not Lupus patients who also had Fibromyalgia were more likely to have Orthostatic Tachycardia, also called Neurally mediated hypotension.

They found that 47.9% of Lupus patients had Neurally mediated hypotension(NMH), Seven of the patients in the study had NMS and POTS. Two patients had borderline results because they didn't show enough of a drop in systolic BP when they stood. 23% of the SLE patients had fibromyalgia.

Eighteen (23.7%) SLE patients had FM and 51 (67.1%) had at least one tender point (TP). The frequency of NMH (first or second stage) in SLE with FM was 58.3% compared with 69.4% in SLE without FM. This indicates that fibromyalgia and NMH being associated with Lupus isn't because NMH causes fibromyalgia.
http://rheumatology.oxfordjournals.org/content/43/5/609.full

This study found in Rheumatology International, July 2006, Volume 26, Issue 9, pp 837–840, showed that 37% of patients in the study who had Lupus also had autonomic symptoms. 18% of them had lab results showing autonomic dysfunction. This dysfunction didn't appear to have anything to do with how long they had had Lupus, lupus activity, disease damage, any particular organ involvement or the presence/absence of peripheral neuropathy. This means they could have autonomic dysfunction without having peripheral neuropathy. http://link.springer.com/article/10.1007%2Fs00296-005-0093-0

Sjogren's Disease effects most notably, the lacrimal glands,(your eyes) and salivary glands(your mouth)  by damaging your ability to produce tears and saliva. It can also damage your lungs, kidneys, bladder, joints, etc.  Sjogren's Disease  sometimes causes autonomic, sensory, and motor neuropathy, as well as CNS lesions/inflammation in the spinal cord and brain. Besides hypotension and tachycardia, these patients often have gastrointestinal problems, difficulty swallowing, headaches, body aches and nerve pain in the arms and legs. They may have hypersensitivity to light, sound, and skin sensation, outside of any migraines.

The thing I find most interesting about POTS and Sjogren's is that dehydration is a symptom of both illnesses. And anhydrosis or the inability to sweat or decreased sweating is a symptom of both diseases. In this case, Sjogren's destroys the sweat glands and in POTS it is caused by nerve damage.  And it would be difficult to tell which one causes which.


Another study  I read at The National Center for Biotechnology Information found the following:

"Patients with POTS have a higher prevalence of autoimmune markers and co-morbid autoimmune disorders than the general population. One in four patients have positive ANA, almost one in three have some type of autoimmune marker, one in five have a co-morbid autoimmune disorder, and one in nine have Hashimoto's thyroiditis." http://www.ncbi.nlm.nih.gov/pubmed/26038344

Other autoimmune conditions that occur with POTS are Multiple Sclerosis (MS),
Ehlers-Danlos Syndrome (EDS) which is more of a connective tissue disease than an autoimmune disease, Celiac Disease, Crohn's Disease, Addison's Disease, Graves Disease, Hashimoto's Thyroiditis, and antiphospholipid syndrome, and Rheumatoid Arthritis.

A severe form of dysautonomia is called Autoimmune Autonomic Ganglionopathy(AAG). Only around 100 people are diagnosed with it each year.